Psychiatric Nursing/Psych NP: The Content and the Lifestyle

[unicornbrain]

Hello all,

I'm brand new to this site, so I've no idea if I'm doing this correctly. Guess we'll find out :). I'm a brand new nurse working on a hospital step-down unit. I've always been interested in psychiatric nursing, but the general reaction from people is, "You'll get stuck passing meds all day." I've been reading this forum, and it appears that you all in the psych nursing world really like your jobs, which is encouraging. Still, I'm wondering: do you feel like you spend too much time passing meds? Do you get to spend TIME with patients, just talking to them? Do you get to lead groups? If anyone out there is a psych NP, do you feel this role is med-management heavy?

I'm asking because, simply, I like people. That's one reason I became a nurse. I like hearing their stories, I like feeling like I've made a difference for someone. I'd like to be in a position where I feel like I'm getting that interaction.

As an aside: do you find yourself greeted with negative-ish responses when you say you are in psych nursing? Is there a reason for this, or is psych nursing just not largely understood?

[Meriwhen, ASN, BSN, MSN, RN]

Actually, I find myself spending more time with patients than I thought I ever would. I do also lead groups and activities on occasion. You see, one of the primary interventions in psych is therapeutic communication: you have to talk to the patient and find out what's going on. A patient's current mental status is not always discernible just by eyeballing them. Yes, you can learn a lot about the patient from what you see, but you have to interact with patients to get the whole picture.

And yes, the other major intervention is medications. However, IMO it's not as extensive as people--usually those with limited experience in psych--make it out to be. I don't pass meds all day--I pass them at the set med times. When I give PRNs/emergency meds, I don't think it's any different or any more frequent than if they were a medical patient (like THEY never ask for PRNs?). Not every patient is medicated to the gills or kept that way...in fact, did you know psych patients, even involuntary ones, retain the right to refuse medication? A lot of nurses don't realize that we can only force meds on a patient in an emergency or with a court order.

Usually I get looks of awe and statements of "I couldn't do that" when they find out I work psych.

Sometimes I do get negative responses from people...and I agree with you: psych disorders and thus psych nursing as a whole are still misunderstood. Many people think it's a matter of patients just needing to "suck it up and get over it". Some think the answer to psych disorders is to "dope them up and lock them up" (translation: medications and keep them out of society). Some people are quick to label patients and make assumptions that aren't necessarily true (my pet peeve: calling difficult patients "borderlines" even if no Axis II is present).

And some think psych is dangerous...and I'll admit there is an increased risk of violence both direct (patient specifically going after staff) and incidental (staff injured during codes trying to care for patient). But psych is far from the war zone they'll make it out to be...most days are rather uneventful, and we work to stop any problems before they escalate out of control. I personally think working the ER is more dangerous.

Then there's the disdain from those who think psych isn't real nursing because there's few nursing "skills" (read: IVs, foleys, EKGs, etc.) used. I'm just using a different skill set, that's all. Or my favorite: those who think psych is "easy." I've seen grown and seasoned nurses cry when they've gotten to the psych floor because they found it wasn't the piece of cake that they thought it'd be.

Anyhow, I either educate or ignore the critics, depending on the circumstances and the person(s) involved.

At the end of the day, I'm happy with what I do, and that's all that matters to me. I may decide to explore other areas both out of curiosity and to help make me more well-rounded as a NP (should I decide to pursue that route). But I really enjoy psych.

Best of luck with your new career, and in finding your niche wherever it may be :)

[Psychcns]

I think out pt psych np is med mgt heavy. But you can find places which give you 1/2 hr for follow ups and 1 to 1 1/2 hour for evals

You can also do therapy

I like med mgt. people talk openly to me and I prescribe meds, do counseling and teaching and coordinate with their therapist

I have a locums forensic job now. Med mgt and team meetings. Collaborating with internists and multidisciplinary staff..very interesting.

Staff nursing can be a lot of passing meds but you also have to assess pts. Which means talking to them. And you can do groups.

[Isitpossible, LPN, LVN]

Hi- I work in psych and have worked in LTC. There is simply no comparison. In LTC, I gave meds to 30 patients which easily took me 2hrs. In psych, I have 8 -12 patients, who don't require crush. I start pouring meds at 8am - finished by 9am!! I have much more time now to actually interact with my patients which I love!

[vegnurse21]

It's nice most of you have that time to spend with patients! Before JACHO got so documentation-heavy I used to spend a ton of time with the patients. We would talk, color, watch ball games, etc on TV. Now between all the documentation, drug users asking for meds constantly, and lower staffing I hardly ever get to do that anymore. We don't do groups anymore, but used to. When we did groups though it was in the midst of all the documentation changes and honestly we were so rushed to get that done our groups were rushed and pretty crappy.

I guess it just depends on where you work. I work in a huge inner city hospital known for cardiac and ortho excellence and are a Magnet recognized hospital. Therefore, they care more about how things LOOK rather than how things really are. It's disappointing to say the least.